BISD VOLUNTEER DRIVER CHECKLIST
If you will be volunteering in an additional capacity other than as a volunteer driver, please complete the
Volunteer Application Process before submitting this form. (Located online at ​www.bisd303.org​).
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I completed the Volunteer Application Process: YES ___ on _______________ (date).
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I am ​only volunteering as a driver​ and not engaged in any other volunteer responsibilities. YES ___
TRIP INFORMATION:​ (If driving for a series of trips such as for a sports season or class, please indicate the approx. date
range)
2/27/2017 - 5/20/2017
Bainbridge High School
DATE OF TRIP:_________________________
SCHOOL: ______________________________________
Competition, Games
PURPOSE OF TRIP: ____________________________________________________________________
Various Fields, Schools
TRIP DESTINATION: ____________________________________________________________________
Bainbridge High School
DEPARTING FROM: _____________________________________________________________________
TBD
TBD
DEPARTURE TIME: ___________________________RETURN
TIME:_____________________________
MAXIMUM # OF STUDENTS TO BE TRANSPORTED IN VOLUNTEER’S VEHICLE: ________________
If you are driving more than one day in succession, please provide a Driving Record from the Department of Licensing, which
can be found at ​http://www.dol.wa.gov/forms/500009.pdf​ or complete online at ​https://fortress.wa.gov/dol/dsdiadr/​.
DRIVING SCREENING / INSURANCE REQUIREMENTS:
NAME OF DRIVER: _______________________________ EMAIL:________________________________
VEHICLE YEAR / MAKE / MODEL: ________________________________ LIC. PLATE #: ____________
Please respond to each of the following with a YES or NO answer and fill in requested information:
YES / NO
_______ I am older than 21 years of age.
_______ I have a valid Washington State driver license.
_______ Driver license #: __________________________________ Expires: _______________
_______ A copy of my license is attached.
_______ I have not had vehicle moving violations or at-fault accidents within the last three years.
If you have had moving violations or at-fault accidents, please list:
_______________________________________________________
_______________________________________________________
_______ I will be driving for more than one day in succession, and my Driving Record is attached.
Revised 1.2017
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_______ I carry minimum auto liability limits of $100,000 per occurrence and $300,000 aggregate combined single limit of
liability (or $100,000/$300,000 bodily injury, $50,000 Property Damage) and uninsured motorist coverage.
INSURANCE COMPANY: ____________________________________ POLICY #: ________________________
_______ Copy of my current insurance card is attached.
_______ I am aware that in the event of an accident while on a school-related activity, any claims will be tendered to my
personal automobile insurance company and my primary insurance.
VEHICLE INSPECTION:
Please respond to each item with a yes or no answer.
_______ There is a working seat belt for the driver and each passenger, and I enforce the wearing of seat belts by all.
_______ My vehicle’s brakes, including the emergency break, are in good working order.
_______ My vehicle’s tires have legal tread depth (at least 3/32”).
_______ My vehicle’s brake lights, turn indicators and headlights are in good working order.
_______ My vehicle’s windows are clear and provide an unobstructed view for the driver.
_______ My vehicle has functioning rear view mirrors (center and left side).
_______ My vehicle has no other physical defects that would interfere with the safety of the driver and passengers.
_______ My vehicle has a rated capacity of ten passengers or less.
_______ If my vehicle has dual airbags, I will not seat children under 12 or small persons in the front seat.
The above information is true and accurate to the best of my knowledge.
Driver’s Signature: __________________________________________________ Date: __________________________
Please submit this with a copy of your current driver license and insurance care.
ADMINISTRATIVE REVIEW:
YES/ NO
_______ If the volunteer will drive more than one day in succession, the driver has provided a motor vehicle abstract.
_______ A Washington State Patrol Request for Criminal History has been completed and checked.
_______ All students have parental permission to ride with a volunteer driver.
_______ All “NO” responses have been addressed satisfactorily.
I have reviewed the above information, and this driver and vehicle are approved for the trip(s).
Signature of Administrator or Designee: ____________________________________________ Date: ______________
Revised 1.2017
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